Why is Glycaemic Control in Type 2 Diabetes Still a Challenge?

Type 2 diabetes (T2D) remains a significant global health challenge, particularly in developing countries. The International Diabetes Management Practices Study (IDMPS) provides valuable real-world evidence on the management and outcomes of T2D over a 12-year period. This article summarizes key findings from the IDMPS, highlighting trends in glycaemic control, therapy use, and care practices.

When to Initiate Basal Insulin?

The IDMPS collected data from 66,088 individuals with T2D across 49 countries, involving 6099 physicians. The study spanned seven cross-sectional waves from 2005 to 2017, with each physician collecting data from ten consecutive patients during a two-week period.

Key Highlights

Glycaemic Control:
The proportion of participants achieving HbA1c <7% decreased from 36% in 2005 to 30.1% in 2017. This decline underscores persistent challenges in achieving optimal glycaemic control.
Therapy Use:
Over 80% of participants were on oral glucose-lowering drugs (OGLDs), with a notable decline in sulfonylurea use. Insulin use increased from 32.8% to 41.2%, with a slight reduction in the time to insulin initiation.
Diabetes Education:
The proportion of participants receiving diabetes education rose from 59.0% to 78.3%, reflecting an increased emphasis on patient education and self-management.
Monitoring:
The frequency of HbA1c measurements improved significantly, with 92.9% of participants having at least two measurements within 12 months by the final wave.

Conclusion

Despite advancements in diabetes management, glycaemic control in developing countries remains suboptimal. The IDMPS highlights the need for systemic changes and better organization of care to improve outcomes for individuals with T2D. Enhanced diabetes education, timely therapy adjustments, and regular monitoring are crucial for achieving better glycaemic control and reducing the burden of diabetes-related complications.

Clincal implications for General Practice

Healthcare providers play a pivotal role in managing T2D. The findings from the IDMPS emphasize the importance of:

Regular Monitoring

Ensuring frequent HbA1c testing to track glycaemic control.

Patient Education

Providing comprehensive diabetes education to empower patients in self-management.

Therapy Optimization

Tailoring treatment plans to individual patient needs, including timely initiation and adjustment of insulin therapy.

By addressing these areas, healthcare providers can significantly improve the quality of care for patients with T2D, ultimately leading to better health outcomes.

This summary provides a concise overview of the IDMPS findings and their implications for healthcare providers. For more detailed information, refer to the original article by Aschner et al. in Diabetologia.

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